Individual provider Active NPI

George D Lyle, M.D.

  • Otolaryngology Physician
  • Winter Haven, FL
National Provider Identifier
1831122811
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
ME64521 Issued in FL
Practice address
160 E Lake Howard Dr
Winter Haven, FL 33881-3155
Phone
(863) 299-1251
Fax
(863) 299-7666
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngic Allergy Physician 207YX0602X ME64521 FL
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X ME64521 FL
Otolaryngology Physician 207Y00000X ME64521 FL Primary

Addresses

Primary practice location

160 E Lake Howard Dr
Winter Haven, FL 33881-3155

Mailing address

8181 NW 154TH St Ste 200
Miami Lakes, FL 33016-5861
Phone (305) 558-3724

Other identifiers 1

IdentifierTypeStateIssuer
373177-400MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address glyle@barranco.medentdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100416000539 FL Practitioner - Otolaryngology 5294862637 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME64521FLMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Barranco Clinic, P.a. Otolaryngology CurrentSince Jul 14, 1993 Accepting new patients

Locations

1920 Don Wickham Dr
Ste 215
Clermont, FL 34711
Phone (352) 394-8808

175 Patterson Rd
Haines City, FL 33844
Phone (863) 358-4849

8181 NW 154th St
Ste 200
Miami Lakes, FL 33016
Phone (225) 298-3537

160 E Lake Howard Dr
Winter Haven, FL 33881
Phone (863) 299-1251

Interoperability endpoints

  • Direct secure messaging: george.lyle.1@18417.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1831122811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8181 NW 154TH ST STE 200",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330165861",
            "telephone_number": "305-558-3724",
            "fax_number": "786-907-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E LAKE HOWARD DR",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338813155",
            "telephone_number": "863-299-1251",
            "fax_number": "863-299-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYLE",
        "first_name": "GEORGE",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "FL",
            "license": "ME64521",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "FL",
            "license": "ME64521",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME64521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373177-400",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "glyle@barranco.medentdirect.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "160 E Lake Howard Dr",
            "city": "Winter Haven",
            "state": "FL",
            "country_code": "US",
            "postal_code": "338813155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

Verify at the official NPI Registry.